Can tip plasty help with breathing problems?

Question

I think tip plasty primarily a cosmetic surgery, but are there any cases in which altering the shape of the tip helps functional breathing problems?

Roger Tsai, MD · Answer

Great question!  Unfortunately, tip refinement will not help with any functional breathing issues, unless your ala is collapsing and needs support.  Otherwise when it comes to functional breathing issues, its either the septum or the turbinates that are causing you to have difficulty breathing, so one or both of these structures need modification.Best of luck and hope this information helps!
- Dr. Roger Tsai  @DrRogerTsai
Board Certified Plastic Surgeon

Manish H. Shah, MD, FACS · Answer

Hello,Thanks for your question. Yes, there are situations in which tip rhinoplasty is helpful at improving functional breathing problems. One is the situation of a plunging tip that block anterior airflow a bit. A tip rhinoplasty the rotates the tip and supports it allows for more direct travel of air into the nostrils. Another situation occurs after an initial rhinoplasty in which scarring narrows the airway. Tip surgery to debulk scar and reopen the airway can often be successful for certain patients. Dr. Shah

Steven M. Denenberg, MD · Answer

When the tip cartilages are strong enough to make the tip look wide and prominent, they often are also strong enough to hold the tip down, making the tip droop. When the tip is worked on, the tip elevates at the same time that it becomes narrower. The woman in the short video that I posted with this answer had a wide tip that was elevated significantly in her rhinoplasty.
When the tip comes up, it can often make breathing easier. It depends on many factors, but it's certainly not unknown.
Remember that rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. The changes I described above require advanced techniques, requiring skill that most plastic surgeons don't possess with expertise. For most noses, it's much better to not have surgery than to have inexpertly-performed surgery. Read my essay on how to stay out of trouble while selecting a rhinoplasty surgeon. 
Your nose is also a perfect example of why computer imaging is mandatory in rhinoplasty. You need to know exactly what the surgeon is planning to accomplish -- what features he thinks he can change, and by how much he thinks he can change them. I always email morphs to my online rhinoplasty consultations. When you see the surgeon's goals in the morphs, you'll know whether he has an eye for an attractive nose, and whether he shares your opinion of what constitutes an attractive nose. You'll also know whether the changes he proposes are large enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. How would you ever get that figured out without the morphs?! 
But remember, you're not the surgeon for his skills with the computer. The doctor must then show you his before and after photos to prove that he can actually accomplish what he draws on the computer.

Nirmal Nathan, MD · Answer

Dear hjbk912,A tipplasty will help with breathing if it is the cause of your nasal obstruction. This is usually more the case with small nostrils and not necessarily the tip. Most breathing problems in the nose are related to the internal nasal valve, which involves the nasal septum. It is inside the nose away from the tip.Best regards,Nirmal R. Nathan, M.D.Certified, American Board of Plastic SurgeryMember, American Society of Plastic Surgeons

Lewis Albert Andres, MD · Answer

Hello!  Thank you for your question!  A tip plasty alone should have no impact on your breathing. Breathing issues are typically a result of issues from the nasal septum, turbinates, or the internal valve. An examination would be needed to determine your issue, but a rhinoplasty alone for contouring of the nose itself would likely make no difference on function. Best wishes!

Suleyman Tas, MD, FEBOPRAS · Answer

Hi,Your breathing issue can be addressed to septoplasty, fixing the insider issues,to fix the overall shape of nose is addressed to Rhinoplasty, your consern both breathing andshape of your nose can be improved by Septorhinoplasty Closed&Atraumatic Technique   will provide you maximal healing with minimal tissue damage.Regards,

Jeffrey Jumaily, MD · Answer

It can. The tip cartilages are also part of the external nasal valve but it all depends on the cause of the breathing problems. This requires an exam and close inspection.

Greg Bran, MD, PhD · Answer

Hi there  and thank you for your question. There are selected cases in which alteration of the shape or orientation of the tip defining cartilages can improve the nasal airflow. This is the case when1)  your tip is pointing downwards and by simply pushing  the tip  upwards you  already feel a significant improvement of airflow through your nose; 2) when the tip  is very pointy or pinched and the sidewalls of the alar cartilages are squeezed against the medial segments. pushing the lateral cartilages gently to the side using Q-tips will open up the airway underneath your tip and improve nasal airflow; 3) when the lateral end of your alar cartilages is turned inwards. Usually you will see small bumps on the inside of your alar walls that stick into your nostril and block the airflow.
All these anatomic variations will only require tip pasty and will significantly improve your nasal breathing. Hope that helps.
Kind regards, 
GB

Johnson C. Lee, MD · Answer

The tip itself is not a contributor to the breathing of the hose. The ala however (The rims of the nostril) do control the external valve of your nose. If you try to breathe in deeply with one side of your nose and the nostrils collapse, you may need grafting down to support the rims to help with functional breathing problems. There are also internal components as well such as the internal valve, turbinates, septum etc which all contribute to airflow. The best way to determine what is needed is to have an in-office evaluation for a more thorough look. Hope this helps!
Johnson C. Lee, MD 
Board-Certified Plastic Surgeon

Andre Panossian, MD · Answer

Normally, tip procedures on the nose shouldn't cause or contribute to breathing problems. However, if you had an overly aggressive trimming of the lower lateral cartilages, then you can have collapse of the external nasal valve. Most of the improvement in breathing comes from manipulation of the septum and the middle nasal vault (ie, spreader grafts). Just to be clear, refining the tip only is for appearance and not so much for function.Read about Dr. Panossian's rhinoplasty technique.

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